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Individual

JODI LORAIN SELF

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
2222 NEON ST, SPRINGFIELD, OH 45503-1880
(937) 688-0464
Mailing address
2222 NEON ST, SPRINGFIELD, OH 45503-1880
(937) 688-0464

Taxonomy

Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
391070
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
RN391070
RN LICENSURE
OH
Enumeration date
07/08/2021
Last updated
07/08/2021
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